Division of Health Informatics and Surveillance May 21 2019 Agenda Welcome and Announcements Overview of Foodborne and Diarrheal Diseases HL7 Case Notification Messages Mike Hughes Division of Foodborne Waterborne and Environmental Diseases CDC ID: 912040
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NNDSS Modernization Initiative (NMI): Overview of Foodborne and Diarrheal Diseases HL7 Case Notification Messages
Division of Health Informatics and Surveillance
May 21, 2019
Slide2Agenda
Welcome and Announcements
Overview of Foodborne and Diarrheal Diseases HL7 Case Notification Messages
Mike Hughes, Division of Foodborne, Waterborne, and Environmental Diseases, CDC
Questions and Answers
2
Slide3Lesliann Helmus, MSPH, CHTS-CP
Associate Director for Surveillance
Michele Hoover, MS
Lead, State Implementation and Technical AssistanceNMI Updates and Timeline
Slide4Announcements:
MQF functionality is now in METS and MQF is being decommissioned.
CSTE hosted webinar on Carbon Monoxide is set for July 22, 2019, 3:30 PM-4:30 PM. Keep a look out for the official invite.
4
Slide5Conditions Added to Generic v2 Only
CDC received approval from the Office of Management and Budget (OMB) to receive case notifications for the following conditions:
Candida auris
, clinical (event code 50263),
Candida auris,
colonization/screening (event code 50264),Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) (event code 50244),Carbon Monoxide Poisoning (event code 32016), andRespiratory Syncytial Virus-Associated Deaths (event code 11646). Please send notifications to CDC for all
2019 cases of the above conditions. Use the generic v2 message mapping guide until disease-specific message mapping guides are available.CDC will post an updated 2019 NNDSS Event Code List on the NNDSS Event Codes & Other Surveillance Resources web page
.
5
Slide6Reminder:
Please upgrade to PHIN Messaging System (PHINMS) v3.1 by June 30
th
, if you have not already done so.
Installation and other guidance documents are available on the PHIN website at
https://www.cdc.gov/phin/tools/phinms/installation.html
6
Slide7NMI Implementation Status May 21, 2019
Piloting Total of 1 (state)
PR
Production Total of 37 (36 states + NYC)
Onboarding Total of 7 (states)
RI
AK
WA
OR
CA
MT
ID
WY
NE
NV
NM
TX
AR
TN
ME
VT
NY
FL
GA
AL
NC
VA
MI
PA
NJ
DE
NH
CT
MA
HI
AZ
LA
OK
KS
CO
UT
SD
MN
WI
IA
MO
IL
WV
MS
KY
OH
IN
MD
SC
ND
DC
NYC
7
Slide8Piloting Status
Message Mapping Guides (MMGs)
Piloting
States Piloting
TB/LTBI
3
AZ, GA, OR
Malaria
4
CT, ID, FL, MI
Trichinellosis
3
FL, MI, WI
Babesiosis
4
CT, FL, MI, WI
RIBD
3
GA, KS, OR
Lyme/TBRD
5
FL, ID, IL, MI, OR
HAI MDRO
3
CO,
MI, OR
Measles/Rubella/CRS
4
AL
*
, AZ, FL,
OR
Total # of Individual
States
12
AL, AZ,
CO, CT, FL, GA, ID, IL, KS, MI, OR, WI
5/21/2019
8
*
Measles Only
Slide9NNDSS HL7 Message Mapping Guide Estimated Timeline
9
Slide10Implementing the Foodborne and Diarrheal Diseases Message Mapping Guide
Michele Hoover, MS
Lead, State Implementation and Technical Assistance
Slide11Starting from the Beginning...
Engage stakeholders
Engage both informaticians and epidemiologists.
“Engage early and often.”
Strongly recommend using Implementation Spreadsheet for documentation of gap analysis and data crosswalk.
This spreadsheet or a similar resource is one requirement of onboarding.
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Slide12Gap Analysis
Includes comparing:
data collected in state surveillance system,
data submitted to CDC previously, including how it was sent,
data requested in the MMG.
Helps identify if updates to the surveillance system are needed,if data needs to be translated to populate the HL7 message correctly,if additional data needs to be collected for cases.
See resources on the Technical Assistance and Training Resource Center webpage Implementing All Other Conditions: Pre-Onboarding.
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Slide13Implementation
Maintain or improve on data submitted through previous methods.
Ensure all data elements previously submitted to the CDC Programs through any legacy methods can be collected in the state surveillance system and sent in the HL7 message.
Request Technical Assistance for additional help by emailing
edx@cdc.gov
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Slide14New Approach for Implementing the FDD Guide
Phased Approach:
Step 1. Implement 4 conditions
Step 2. Implement other 4 conditions
By using this approach, the jurisdiction will be credited with implementing 2 guides.
All-Inclusive Approach:
Step 1. Implement all 8 conditionsBy using this approach, the jurisdiction will be credited with implementing 3 guides.
OR
Note: Implementation order of the FDD tabs is up to the jurisdiction.
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Slide15Overview: Foodborne and Diarrheal Diseases HL7 Case Notification Messages
Mike HughesNational Surveillance TeamEnteric Diseases Epidemiology BranchDivision of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging Zoonotic Infectious DiseasesCenters for Disease Control and Prevention
Slide16Overview and General GuidanceFoodborne and Diarrheal Diseases HL7 Case Notification Messages
Slide17Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG) Overview
Guide for all jurisdictions sending data elements via HL7 for multiple nationally notifiable conditionsSTEC, salmonellosis, shigellosis, campylobacteriosis, cryptosporidiosis, cyclosporiasis, cholera/vibriosis, typhi/paratyphi infection
Contains subset of data elements sent by EIP sites only to FoodNetIncludes HUS, listeriosis, yersiniosis, and from select sites ETEC
Designed to be used in conjunction with Generic v2 MMG
Conditions
not in the FDD MMG: listeriosis, botulism
Slide18Context of foodborne, waterborne, and parasitic disease surveillanceSome CDC surveillance systems rely on:
1) “legacy” modes of data transmission (e.g. paper case report forms (CRFs), .CSVs) and2) basic demographic and clinical information supplied by public health surveillance partners via NNDSS
Multiple CDC programs involved: Enteric bacterial, waterborne, parasiticEffort to standardize vocabulary, data elements, data structureFDD MMG consists of data elements from CRFs and position statements, where available
Slide19Transition from legacy transmission to HL7CDC programs designated “high priority” data elements.They are essential in order to cease legacy data transmission.
High priority designation was based on:1) Existing surveillance i.e. critical information currently in case reports2) Data elements designated by CSTE for national transmission
3) Epidemiologic need (e.g. risk factors and clinical manifestation)
Slide20General guidance: Repeating groupsGenerally used for:
Signs and symptomsAntibiotics (before or current illness)Exposures (e.g. Travel)Lab interpretive diagnosticIndustry and occupation
Antimicrobial susceptibility testing
Example: Signs and symptoms (STEC)
“Diarrhea”
Yes/No/Unknown
“Bloody Diarrhea”
Yes/No/Unknown
“Abdominal Pain”
Yes/No/Unknown
Repeat 3x for each symptom
Slide21General guidance: Lab interpretative sectionLaboratory interpretive repeating group is essential to foodborne and waterborne disease surveillance
Most tabs have a laboratory interpretative sectionRepeats once for each diagnostic test resultException: COVIS repeats once per specimenStandardized across the guide, it consists of ~18 data elements
Data element priorities might differ by programFor example, national typhoid form contains specimen source, specimen date, and
serotype
. Therefore, these data elements are high priority for this condition.
Slide22Program-Specific GuidanceFoodborne and Diarrheal Diseases HL7 Case Notification Messages
Slide23Cholera and Vibriosis Reflects the information currently collected on the Cholera and Other Vibrio Illness Surveillance (COVIS) System case report form.
Aim to maintain completeness of data in transition from legacy to HL7Key differences:Data elements in laboratory, clinical, and seafood investigation section are designed as repeating groupsSeafood investigations require identifier to link investigation to traceback
Value sets are included for variables that in previous versions of the COVIS form were free textExamples: Vibrio species, type of seafood investigated
Slide24Cholera and Vibriosis (Continued)HL7 message for cholera and vibriosis should include:
Case Patient informationLaboratory results for culture and culture-independent diagnostic testingClinical information including signs and symptoms, past medical history, antibiotic useTravel history
Seafood and water exposuresSeafood investigation and traceback informationCholera exposure information, as appropriate
Slide25S. Typhi and S. Paratyphi Infection
Reflects information collected for National Typhoid and Paratyphoid Fever Surveillance (Legacy name)Aim to maintain completeness of data in transition from legacy to HL7Annotated case report form is availableState can stop sending CRFs once sending new HL7 messages
Send confirmed cases (See Position Statement 18-ID-08)
Slide26S. Typhi and S. Paratyphi Infection (Continued)
HL7 message for S. Typhi and S. Paratyphi Infection should include:State Lab Isolate ID Number (FDD_Q_1141)Clinical information including signs and symptoms*Antimicrobial susceptibility testing*Vaccine history*
Travel history*Specimen collection and serotype**Repeating groupsKey differences:
Use
Date of Specimen Collection
(FDD_Q_1127) instead of isolation dateUse Country of Usual Residence (INV501 in Gen v2) instead of citizenship
Slide27CyclosporiasisConfirmed & Probable cases nationally notifiable since January 1999 (See Position Statement 09-ID-04
)Legacy systems the MMG will replace:Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ)8-page questionnaire used for surveillance during “outbreak season” (May
–August); data submitted electronically via Epi Info or paper-based PDFCyclosporiasis Case Report Form (CRF)2-page questionnaire used for national surveillance outside “outbreak season” (September
–April); data submitted via paper-based PDF
Slide28Cyclosporiasis (Continued)Priority data elements that are most essential for guiding cyclosporiasis epi investigations and retiring legacy systems:
Signs and SymptomsTravel HistoryFood Exposure History sectionsEvents History and Ill Contacts sectionsEpidemiology Laboratory section
Slide29Cryptosporidiosis Data elements reflect CryptoNet case investigation form
Transition to also collecting exposure data to advance understanding of Cryptosporidium transmissionGenotypes and species can have unique host rangesNeed molecular characterization to distinguish
Can provide insight into possible exposuresImportant exposuresContaminated recreational water, drinking water, or food
Infected people or animals
Slide30Cryptosporidiosis (Continued)HL7 message for Cryptosporidiosis should include:
Repeating groups:Recreational waterDrinking WaterRaw or Unpasteurized ProductAnimal Exposure
Preferred values (FDD_Q_32): Calf, Cow, Kid, Goat, Sheep, LambLarge GatheringChildren in ChildcareNon-repeating groups:
Animal Manure Contact Within 14 Days Before Symptom Onset (FDD_Q_919)
Visit Animal Environment Within 14 Days Before Symptom Onset (FDD_Q_925)
Sexual Contact Within 14 Days Before Symptom Onset (FDD_Q_923)Performing Laboratory Specimen ID (LAB202)
Slide31Shiga toxin-producing E. coliSupports STEC Initiative
Collection and transmission of standard information: demographic, exposure, clinical, and outcome dataLink with sequencing data to detect outbreaks and more rapidly identify shared exposures among casesPair epi with genetic information to better understand risk factors for severe disease
Submit confirmed and probable casesNo legacy case surveillance or national case report formSample annotated case report form is availableData elements defined by CSTE (See Position Statement 13-ID-01)
Slide32Shiga toxin-producing E. coli (Continued)HL7 message for STEC should include:
PulseNet ID (FDD_Q_1140)Probable – Lab (FDD_Q_1109), Probable – Epi (FDD_Q_1110)Signs and symptomsPreferred values: Diarrhea, bloody diarrhea, abdominal crampsFood exposures (e.g. ate ground beef, ate romaine lettuce)
Exposure window – 7 days, or specify otherwiseLab interpretive diagnostic repeating group
Slide33Salmonellosis, shigellosis, and campylobacteriosisFDD MMG tabs currently have very few data elementsEnhanced surveillance planning ongoing for salmonellosis
Prioritize data elements normally sent to Laboratory Enteric Disease Surveillance (LEDS) and PulseNetOrganism (41852-5)Performing Laboratory Specimen ID (LAB202)Performing Laboratory Type (82771-7)
Salmonella Serogroup (FDD_Q_902)
Slide3415% of U.S. population
(48 million people)
Foodborne Diseases Active Surveillance Network (FoodNet)
Collaboration among CDC, 10 state health departments, USDA-FSIS, and FDA
Component of Emerging Infections Program (EIP)
Laboratory-based active surveillance for Campylobacter, Cyclospora, Listeria, Salmonella, Shiga toxin-producing E. coli (STEC), Shigella, Yersinia, and Vibrio; pediatric hemolytic uremic syndrome; for select sites Enterotoxogenic E.coliCollects information on:Clinical outcomesAntibiotic useOutbreakTravelExposuresLaboratory
Slide35Foodborne Diseases Active Surveillance Network (FoodNet) (Continued)
Key for implementationPrioritization is based on current FoodNet variables and value sets Laboratory repeating block critical for FoodNet surveillanceMust maintain current data quality
Overlap with national programsWhere there are data elements in common with other programs, map the most specific valuesDefer to FoodNet guidance when mapping the laboratory repeating groupFoodNet guidance documents address
Nuances in reporting
Mapping from FoodNet variables to MMG fields
Slide36Resources for HL7 ImplementationFoodborne and Diarrheal Diseases HL7 Case Notification Messages
Slide37ResourcesELC Cooperative AgreementELC funding strategy: Grantees can request staff, system enhancements, etc. to electronically
collect and transmit routine surveillance data.National surveillance SME supportAnnotated case report forms
NNDSS Technical Resource Center:cdc.gov/nndss
/
trc
/index.html
Slide38Resources Continued:NBS Page Builder Templates
Page builder templates will be developed for all conditions in the FDD MMGPage templates will be released once they are completed following review by surveillance communityGet involved: NEDSS Base System SME calls
Questions: edx@cdc.gov
Slide39ConclusionGap analysisTool to compare the data elements in the MMG to your agencies surveillance system
Occurs early in the onboarding processGoalsAdvance understanding of disease burden and transmissionSupport multistate outbreak investigations with common data elements reported across different jurisdictions
Slide40Federal Surveillance PartnersDivision of Foodborne, Waterborne, and Environmental Diseases
Katie FullertonEnteric DiseasesMike HughesMike JuddErin Stokes
Karen WongFoodNetKelly BarrettDanielle Tack
Parasitic Diseases
Cody Bennett
Shannon CasillasWaterborne DiseasesJennifer CopeMichele HlavsaZach MarshAriana Perez
Slide41Contact for More InformationCSELS/Division of Health Informatics and Surveillance:
edx@cdc.gov
Division of Foodborne, Waterborne, and Environmental Diseases:National: Mike Hughes (wuw8@cdc.gov)
FoodNet: Danielle Tack (
dot7@cdc.gov
)
Slide42Questions and Answers
Text x
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Slide43Subscribe to monthly NMI Notes
news updates at https://www.cdc.gov/nndss/trc/news/
Access the NNDSS Technical Resource Center at
https://www.cdc.gov/nndss/trc/
Request NNDSS technical assistance or onboarding atedx@cdc.gov Next NNDSS eSHARE is July 16, 2019 – details at https://www.cdc.gov/nndss/trc/onboarding/eshare.html
Slide44Appendix
Slide45S. Typhi and S. Paratyphi Infection (Continued)
New condition codes acceptable in HL7 messages:50267: Salmonella enterica Typhi infection (S. Typhi
infection) 50266: Salmonella enterica serotypes Paratyphi A, B (tartrate negative), and C (
S
. Paratyphi) infection
50265: Salmonellosis (excluding S. Typhi infection and S. Paratyphi infection) Retired codes:10240: Typhoid fever (caused by Salmonella Typhi)50236: Paratyphoid fever (caused by Salmonella serotypes Paratyphi A, Paratyphi B [tartrate negative], and Paratyphi C50242: Salmonellosis (excluding paratyphoid fever and typhoid fever)*National notifiable disease event code changes for Typhi and Paratyphi Infection based upon 2018 Council of State and Territorial Epidemiologists position statement revising the case definitions.
Slide46General guidance: Gen v2Many data elements are common across the national surveillance programs:
Local subject IDLocal record IDReporting stateState of residenceSubject’s sexAge at case investigation
Age unit at case investigationSubject hospitalizedSubject diedOutbreak indicatorOutbreak name